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CITY OF YELM - BUILDING DEPARTMENT
RESIDENTIAL CERTIFICATE OF OCCUPANCY
Building Address
15770 Yelm Terra Way SE
Everqreen State Builders
P.O. Box 39753
Lakewood, WA 98439-0753
Owner Name
Owner Address
Building Permit Number
BLD-05-0042- YL
Plan Number'
2150S/2
Remarks
Areas Inspected
All Code Required
Special Conditions
None
Building Official
Gary Carlson
Date
July 13, 2005
This structure is in compliance with the International Residential Code (Chapter
51-51 WAC) as adopted by the Washington State Building Code Council pursuant
to Chapters 19 27 and 70 92 RCW, effective July 1, 2004
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FROM YELM SEWER DEPT
FAX 1'-10 360-458-m66
Jul ~5 2005 12 22PM Pi
FAX TRANSMISSION
YELM
WA!JHINaTON
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CITY OF YELM
P.o. BOX 479 - 931 NP ROAD NE
YELM, WA 98597
360-458-8411
FAX 360-458-8l66
DATE 7- 5''"'05
FAX#
PAGES: I, including this
Cover sheet
From: RA.uOY
Subject: H oJ. 'S G P I~A L'S / ~~ L"l ThrUfT
COMMENTS: )...DT It, 91 15'7cr-~ ) 0411-1 Ave:. $. e ')5 q{/I(lJ:I(j
LOT 0(0) 1~-77D (rELm ~ ~
LJA'f J.~;
[i) -SqC{) .DC)
** If you do not receive all copies or any copy is rot legible, please call (360) 458~8411
as soon as possIble
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CITY OF YELM INSPECTION LOG
PROJECT
'IT M 10
PERMIT NUMBER 0 s- Do 42.. -- Y L
ADDRESS I S 77 0 J~ .j~ WOv..\ ~ t-
I
SET BACKS Date
Front ""l...tt
Rear ~ '-'
SIde/flankIng ,
SIde
FOOTING REBAR
FOOTING WALL
o 12" o 6"
1s 16" b 8"
h) 0 other o other
1 D 0 reqUIred vents
Date \V ALL REBAR Date
Comments
COMBINED FRAME/ EXTERIOR SHEAR WALL INSPECTION
Hold downs 0 Shear NaIllOg 0
Frame If Gas/Propane tfit ~ ~~
PlumblOg f ul}v f)n MechanIcal 0
Comments
~Gas
~ Foam and Seal
Comments ~ 8).) ~15' 1:-1 ~
Of ~I
SHEET ROCK/SHEAR \VALL NAIL
INSULA TION
o ElectrIc
o Vapor barner
o Other
, PYA
Comments
OTHER
Comments
g1 ElectrIcal
JI InsulatIOn
o CIvil FlOal I1f Landscape FlOal 0 C of 0
o SIte DralOage l) Sidewalk
Comments
o
o
City of Yelm
Community Development Department
Building Division
Phone (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0042- YL
Issue Date 02/15/2005
(Work must be started within 180 days)
Receipt No
35602
Applicifr'lt:
Name Evergreen State Builders
Phone:
253-475-6622
Address. POBox 39753
City' Lakewood
State WA Zip 98499
Property Information
Site Address 15770 Yelm Terra Way SE
Assessor Parcel No 85840009000
Subdivision' Yelm Terra
Lot: 90
Contractor'lnform atioll.
Name Evergreen State Builders
Contact: McCullem, Tom
Phone, 253-475-6622
Address. P O. Box 39753
City' Lakewood
State WA Zip
Contractor License No EVERGSB980PB
Expires: 10/02/06275
Business License 1042.0
Project Information
Project: Yelm Terra
Description of Work: Plan 2150 S/2 Lot 90
Sq. Ft. per floor' (1 st) 888 (2nd) 1262 (3rd) 0 Garage 432 Basement 0
Heat Type (Electric, Gas, Other) GAS
Fees
Item Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
--------------------------- -------------
Building Permit 100-500k 1,276 77 993 75 283 02 5 6000 50,5400 $1,000
Building Plan Review 539 44 000 000 o 0000 o 0000
Mechanical Permit 7875 000 000 0,0000 o 0000
Plumbing Permit 132.00 2000 112.00 7 0000 16 0000 Fixture
Sewer Inspection 145 00 000 145 00 145 0000 1 0000 ERU
Water ERU 1 500 00 000 1 500 00 1,5000000 1 0000 ERU
Water Meter (SFD) 300 00 300,00 000 o 0000 o 0000
Water Deposit 4000 4000 000 o 0000 0,0000
Traffic Facilities Charge 757 50 0.00 757 50 7500000 10100 Peak PM Trip
Sewer Deposit 5000 50,00 000 o 0000 o 0000
State Building Fee 450 450 000 o 0000 0,0000
Sewer ERU 5,41700 000 5,41700 5,417 0000 1 0000 ERU
TOTAL FEES $10,240.96
Applicant's Affadavit:
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State of Washington.
Signature f.. -
OFFICIAL USE ONLY
# Sets of,Prints:
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RECEIPTNo 35601
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REF NO
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RECEiVED
****TEN THOUSAND TWO HUNDRED SIXTY SEVEN DOLLARS & 69 CENTS
RE(.EIVEiJ FROiv1
DilTE
REC NO
AMOUNT
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD. WA 98499
BLD-05-0041-YL
SITE: 15767 104TH AVE SE
02/14/05
35601
10.267.69 CHECK
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1301.19. PLNREV549.75. MECHPRHT84 75. PLMBPRMT118. S/INSP145.W/ERU1500
W/MTR300. W/DEP40. TRAFF757 50. S/DEP50. STFEE4 50, S/ERU5417.
, ." II:' . .
In nn.. .....m__ ,_..,
11;1' 0' TH~ t>+"'~1 C IT, Y 0 F
11'.S~"1 ,
~,,~ YELM
~,.~ -....:: PO Box 479
./ ; elm Wi> 98597
"YE!;.~",. 380-450.8403
RECEIPT No 3 5 6 0 2
RECEIVED
****TEN THOUSAND TWO HUNDRED FORTY DOLLARS & 96 CEN~
RECEIVED FROM DATE REG NO /" /\MOIJNT
~~-~-
MISCELLANEOUS
DIANA
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD. WA 98499
BLD-05-0042-YL
SITE: 15770 YELM TERRA WY SE
02/14/05 3560'"
10.240.96 CHECK
BLDPRMT1276 77. PLNREV539 44. MECHPRMT78 75, PLMPRMT132. S/INSP145, W/ERU1500
W/MTR300, W/DEP40. TRAFF757 50, S/DEP50, STFEE4.50. S/ERU5417,
-~~ -
. .'~' v
RECEIPT No 35603
RECEIVED
****TEN THOUSAND TWO HUNDRED SIXTY SIX DOLLARS & 03 CENTS
RECEIVED FROM
DATE
REG NO
AMOUNT
REF NO
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD. WA 98599
BLD-05-0040-YL
SITE 15780 104TH AVE SE
02/14/05 35603
10.266 03 CHECK
PENDING
MISCELLANEOUS RECEIPT
DIANA
BLDPRHT1299.32, PLNREV548.96. MECHPRMT78 75. PLMBPRMT125. S/INSP145. W/ERU1500
W/MTR300. W/DEP40, TRAFF757 50. S/DEP50. STFEE4 50. S/ERU5417.
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Yelm School District
ATTN SUSAN CROY
PO BOX 476
YEL~l, \~A 98597
360-458-1900
Sold to. 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN STATE
5516 75TH ST W #1
LAKEWOOD, WA 98499
# 5747 10 02/15/05
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 5,13300 5,13300
CKV #2 FOR YELM TERRA DEVELOPMENT LOT
43,7290
----------
SubTotal 5,133 00
Total Due
Check
5 J 133 00
5 ,133 00
----------
----------
Thank you
PLEASE KEEP THIS RECEIPT I ! I
CITY OF YELM
RESIOENTIAL BUilDING PERMIT APPlICATIP~FORM Q' 0
Project Address: ~~7 V /",,~-;i_ 7T Parcel It- ~-t 5<(5 t 000 10 0
Subdivision: Ye (h1 -ref r ~ Lot #. ?t' Zoning; ..&Ui. g Ii! --f{.fIh1. I I j
~ew Construction U Re-Modell Re-Roof I Addition u Home Occupation Sign
u Plumbing u Mechanical U Mobile I Manufactured Home Placement U Other
Project DeScri~n1Scope of Work:~ t() it?. -FUAil" 01 ~ &' duJ, CL I
Project Value: ;;(/7. 96ZJ
BuildingArea(sq.ft) 1stFloorSS& 2OOFloor/Z6Z Garage ~jz... Deck/lf.O
Basement Carport Patio .z / t...
# Bedrooms-5' # Bathroomsj Heating~ER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME.
ADDRESS
CITY
ICENSE #
EMAlL
ZIP tjxf@;2 TELEPHONE
GENERAL CONTRACTOR \~cr.s ~ TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTORS LICENSE # t:14 EXP DA T . CITY LICENSE #
PLUMBING CONTRACTOR,J VI X.A ~.,.\. MA~~ . ....;TELEPHONE~) .s:."37 8'90 C)
ADDRES~f~ P ___ EMAIL
CITYJa STATEu...h/ ZIP 8YS -\ FAX 2<:<;,~-q?~
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAl CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
ZIP
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools. if applicable
I hereby certify that the above Information is correct and that the construction on, and the occupancy and the use of the
above described property wUI be In accordance with the laws, rules and regulations of the State of Washington and the
City of Velm.
//~--~ /-7-~
Applicant's Signature ~ Date
Owner I Contractor~ner's Agen Contractor's Agent (Please circle one.)
All permits are non-transferable and will expire if work authorized by such permit is not begun
within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days
105 Yelm Avenue WeBt
PO Box 479
Yelm, WA 98597
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wo....
o I LOT '30 0
EVERGREEN STATE BUILDERS
I YELM TERRA
15170 YhM TERRA WAY SOUTHEAST
YELM, WA
SITE PLAN APPROVAL
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